Testing the Testers: Are Young Men Who Have Sex With Men Receiving Adequate HIV Testing and Counseling Services?

• Type of Material: Article
• Authors: Jose A. Bauermeister, University of Pennsylvania; Jesse M. Golinkoff, University of Pennsylvania; Willey Y. Lin, University of Pennsylvania; Kristina F. Claude, University of North Carolina; Keith J. Horvath, University of Minnesota; Nadia Dowshen, Children's Hospital of Philadelphia; Anderson Schlupp, Children's Hospital of Philadelphia; Willliam J. Vickroy, Children's Hospital of Philadelphia; Kimberly Desir, Children's Hospital of Philadelphia; Alexander V. Lopez, Children's Hospital of Philadelphia; Marne Castillo, Children's Hospital of Philadelphia; Mary Tanney, Children's Hospital of Philadelphia; Taylor A. Wimbly, Emory University; Kingsley Leung, Emory University; Patrick S Sullivan, Emory University; Dalisa L. Santiago, Baylor College of Medicine; Rogelio Hernandez, Baylor College of Medicine; Mary E. Paul, Baylor College of Medicine; Lisa Hightow-Weidman, University of North Carolina; Sonia Lee, National Institute of Child Health and Human Development; Robert Stephenson, Emory University
• Language: English
• Date: 2019-12-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Final Published Version
• Copyright Statement: Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/QAI.0000000000002173
• Title of Journal or Parent Work: Journal of Acquired Immune Deficiency Syndromes
• ISSN: 1525-4135
• Volume: 82
• Start Page: S133
• End Page: S141
• Grant/Funding Information: This work was also supported by the Center for AIDS Research at the University of Pennsylvania (P30 AI 045008); Emory University (P30AI050409); the University of North Carolina at Chapel Hill (P30AI50410); the Penn Center for AIDS Research (CFAR) (P30 AI 045008 - Ronald Collman, PI); the Penn Mental Health AIDS Research Center (PMHARC) (P30 MH 097488 - Dwight Evans, PI); and the CFAR Social & Behavioral Science Research Network National Scientific Meeting (SBSRN) (R13 HD 074468 - Michael Blank, PI).; Supported by the National Institutes of Health Adolescent Medicine Trials Network for HIV/AIDS Interventions and the University of North Carolina/Emory Center for Innovative Technology (U19HD089881).
• Keywords: quality assurance; mystery shopping; testing resources; community; systems
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

BACKGROUND: The United States Centers for Disease Control and Prevention promote HIV testing every 6 months among young men who have sex with men (YMSM) to facilitate entry into the HIV prevention and care continuum. Willingness to be tested may be influenced by testing services' quality. Using a novel mystery shopper methodology, we assessed YMSM's testing experiences in 3 cities and recommend service delivery improvements. METHODS: We assessed YMSM's experiences at HIV testing sites in Philadelphia (n = 30), Atlanta (n = 17), and Houston (n = 19). YMSM (18-24) were trained as mystery shoppers and each site was visited twice. After each visit, shoppers completed a quality assurance survey to evaluate their experience. Data were pooled across sites, normed as percentages, and compared across cities. RESULTS: Across cites, visits averaged 30 minutes (SD = 25.5) and were perceived as welcoming and friendly (70.9%). YMSM perceived most sites respected their privacy and confidentiality (84.3%). YMSM noted deficiencies in providers' competencies with sexual minorities (63.4%) and comfort during the visit (65.7%). Sites underperformed on Lesbian, Gay, Bisexual, Transgender visibility (49.6%) and medical forms inclusivity (57.95%). Sites on average did not discuss YMSM's relationship context (49.8%) nor provide risk reduction counseling (56.8%) or safer sex education (24.3%). Sites delivered pre-exposure prophylaxis information and counseling inconsistently (58.8%). CONCLUSIONS: Testing sites' variable performance underscores the importance of improving HIV testing services for YMSM. Strategies are recommended for testing sites to promote cultural sensitivity: funding staff trainings, creating systems to assess adherence to testing guidelines and best practices, and implementing new service delivery models.